Provider Demographics
NPI:1508814781
Name:EYE CARE ASSOCIATES OD PA
Entity Type:Organization
Organization Name:EYE CARE ASSOCIATES OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLICK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:919-847-0187
Mailing Address - Street 1:7100 SIX FORKS RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6156
Mailing Address - Country:US
Mailing Address - Phone:919-847-0187
Mailing Address - Fax:919-676-2231
Practice Address - Street 1:2042 KILDAIRE FARM RD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6614
Practice Address - Country:US
Practice Address - Phone:919-851-9995
Practice Address - Fax:919-859-4172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0233JOtherBLUECROSS
NC790233JMedicaid
NCCK2419OtherRAILROAD MEDICARE
NC1062150001Medicare NSC
NC0233JOtherBLUECROSS